The Iowa Research Network IRENE is a PBRN affiliated with the IAFP and the University of Iowa Department of Family Medicine. Its purpose is to create new knowledge that is relevant to rural primary care clinicians and their patients, with the outcome of improving patient care through the development of a primary care research laboratory. For category-1 funding, we intend to build the 1) organizational structure of IRENE to enable linkages between practicing clinicians and researchers, improving communication and establishing long-term commitments to common goals for research, 2) capacity building infrastructure to grow the network, especially in MUCs and among minority practices, certify physicians and offices for Federal Wide Assurance, and develop and test communication pathways to collect and disseminate research findings to practitioners, and 3) research development process to generate grant applications, conduct research, assure integrity of projects, and produce products of research for dissemination. The proposed pilot research project will address translation of research to care for diabetic patients. Although studies have evaluated physician adherence to practice guidelines in the management of patients with diabetes, few have assessed patient and physician factors that prevented adequate glycemic control, and none has assessed these factors in a rural setting. This study will evaluate these factors and test an intervention based on this evaluation. The study will involve at least 50 physicians, each of whom will enroll, sequentially from a random date, two patients with poorly controlled diabetes. All physicians and patients will be interviewed to collect information about barriers to care, and an interdisciplinary committee including a patient advocate will review this information. This committee, with input from prominent rural family physicians, will develop an intervention for the barriers to care and test this in an RCT. By examining the barriers and testing proposed remedies, we should learn a great deal about contributors to poor diabetic control and methods for improving diabetic care in primary care, particularly in rural settings.